title: Screening rectal culture to identify fluoroquinolone-resistant organisms before transrectal prostate biopsy: do the culture results between office visit and biopsy correlate?
abstract: OBJECTIVE
  To investigate the performance of screening rectal cultures obtained 2 weeks before transrectal prostate biopsy to detect fluoroquinolone-resistant organisms and again at transrectal prostate biopsy.
  
  
  METHODS
  After institutional review board approval for observational study, we obtained a rectal culture on patients identified for a prostate biopsy but before antibiotic prophylaxis from September 12, 2011 to April 23, 2012. The specimen was cultured onto MacConkey agar with and without 1 μg/mL ciprofloxacin. We then obtained a second rectal culture immediately before prostate biopsy after 24 hours of ciprofloxacin prophylaxis. All cultures were blinded to the practitioner until the end of the study.
  
  
  RESULTS
  Of 108 patients enrolled, 58 patients had both rectal cultures for comparison. The median time duration between cultures was 14 (6-119) days. There were 54 of 58 concordant pairs (93%), which included 47 negative cultures and 7 positive cultures; 2 patients (3%) who were culture negative from the first screening culture became positive at biopsy. Sensitivity, specificity, negative, positive predictive values, and area under the operator curve were 95.9%, 77.8%, 95.9%, 77.8%, and 0.868, respectively. When Pseudomonas spp. are removed from the analysis, the area under the curve is increased to 0.927.
  
  
  CONCLUSIONS
  Screening rectal cultures 2 weeks before prostate biopsy has favorable test performance, suggesting screening cultures give an accurate estimate of fluoroquinolone-resistant colonization.
authors.affiliation: Department of Urology, University of California, Irvine, CA, USA. mliss008@gmail.com
authors.forename: Michael A
authors.initials: MA
authors.lastname: Liss
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Nakamura
authors.forename: Rachel
authors.initials: R
authors.lastname: Meuleners
authors.forename: Surendra B
authors.initials: SB
authors.lastname: Kolla
authors.forename: Atreya
authors.initials: A
authors.lastname: Dash
authors.forename: Ellena M
authors.initials: EM
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D019540:Area Under Curve; D001424:Bacterial Infections / Q000175:diagnosis* / Q000517:prevention & control; D001707:Biopsy, Needle; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011467:Prostate / Q000473:pathology*; D012372:ROC Curve; D012007:Rectum / Q000382:microbiology*; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin